GRACE HOSPITAL: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- GRACE HOSPITAL (EIN 34-0714479)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-05-15
- IRS object ID
- 201421359349305202
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-05-15T12:19:48-05:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 340641962 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRUNER-COX LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 388 S MAIN STREET SUITE 403 | AddressLine1 |
| City | AKRON | City |
| State | OH | State |
| ZIP Code | 44311 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 340714479 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRACE HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | GRAC | NameControl |
| Phone | 4402043500 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 17730 LORAIN AVE | AddressLine1 |
| City | CLEVELAND | City |
| State | OH | State |
| ZIP Code | 44111 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | RAJIVE KHANNA | Name |
| Title | PRESIDENT AND CEO | Title |
| Phone | 2164563880 | Phone |
| Date Signed | 2014-05-15 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | LISA M HILLING | Name |
| PTIN | P01624111 | PTIN |
| Phone | 3303760100 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | RAJIVE KHANNA | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 17730 LORAIN AVE | AddressLine1 |
| City | CLEVELAND | City |
| State | OH | State |
| ZIP Code | 44111 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 28613715 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.GRACEHOSPITAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1910 | YearFormation |
| State Legal Domicile | OH | StateLegalDomicile |
| Activity Or Mission Description | TO SERVE AS A CENTER FOR EXCELLENCE IN THE PROVISION OF SPECIALIZED HEALTH CARE SERVICES AND COMFORT FOR PATIENTS AND FAMILIES COPING WITH CATASTROPHIC ILLNESS AND INJURY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 11 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 290 | TotalNbrEmployees |
| Total Nbr Volunteers | 9 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 378474 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 408352 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 26500361 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 27909698 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 118105 | InvestmentIncomePriorYear |
| Investment Income Current Year | 251200 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 25966 | OtherRevenuePriorYear |
| Other Revenue Current Year | 44465 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 27022906 | TotalRevenuePriorYear |
| Total Revenue Current Year | 28613715 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 109301 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 94969 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 10218393 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 11832769 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 13744727 | OtherExpensePriorYear |
| Other Expenses Current Year | 14016040 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 24072421 | TotalExpensesPriorYear |
| Total Expenses Current Year | 25943778 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 2950485 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2669937 | RevenuesLessExpensesCY |
| Total Assets BOY | 14796962 | TotalAssetsBOY |
| Total Assets EOY | 16489806 | TotalAssetsEOY |
| Total Liabilities BOY | 7095063 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 5549154 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 7701899 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 10940652 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO SERVE AS A CENTER FOR EXCELLENCE IN THE PROVISION OF SPECIALIZED HEALTH CARE SERVICES AND COMFORT FOR PATIENTS AND FAMILIES COPING WITH CATASTROPHIC ILLNESS AND INJURY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 22261025 | Expense |
| Grants | 94969 | Grants |
| Revenue | 28157898 | Revenue |
| Description | GRACE HOSPITAL IS A NON-FOR-PROFIT, LONG-TERM ACUTE CARE HOSPITAL LOCATED IN CLEVELAND, OHIO DEDICATED TO PROVIDING PERSONALIZED CARE TO MEET THE NEEDS OF PATIENTS COPING WITH CATASTROPHIC OR CHRONIC INJURY OR ILLNESS REQUIRING EXTENDED HOSPITALIZATION. THE HOSPITAL WAS FOUNDED IN 1910 BY A GROUP OF PHYSICIANS WHO WERE COMMITTED TO MEETING THE HEALTHCARE NEEDS OF THE COMMUNITY. GRACE HOSPITAL HAS CONTINUOUSLY PROVIDED SERVICES FOR ITS PATIENTS. IN 1995, GRACE HOSPITAL EARNED APPROVAL TO BECOME THE FIRST CERTIFIED LONG-TERM ACUTE CARE HOSPITAL IN BOTH THE CITY OF CLEVELAND AND CUYAHOGA COUNTY. THE HOSPITAL PRESENTLY SPONSORS SEVERAL INPATIENT SERVICES INCLUDING COMPLEX MEDICAL, PULMONARY, REHABILITATION, VENTILATOR WEANING, LEFT VENTRICAL ASSIST DEVICE, TRANSPLANT SUPPORT, WOUND CARE, AND NEUROLOGICAL REHABILITATION PROGRAMS. THESE SERVICES ARE PROVIDED AT INPATIENT SATELLITES LOCATED WITHIN FAIRVIEW, LAKEWOOD, SOUTH POINTE AND BEDFORD HOSPITALS. GRACE HOSPITAL IS COMMITTED TO PROVIDING PERSONALIZED HEALTHCARE CHARACTERIZED BY QUALITY, ACCESSIBILITY, EFFICIENCY, AND COST EFFECTIVENESS. THE HOSPITAL IS SENSITIVE TO AGE, CULTURAL, AND ECONOMIC VARIATIONS, AND IS CONTINUOUSLY ASSESSED AND IMPROVED THROUGH A QUALITY MANAGEMENT PROGRAM. GRACE VOLUNTARILY MAINTAINS A CHARITY CARE POLICY THAT PROVIDES CARE TO INDIVIDUALS REGARDLESS OF ABILITY TO PAY. THE HOSPITAL IS ALSO COMMITTED TO EMPLOYING INDIVIDUALS TO MATCH CULTURAL DIVERSITY OF ITS PATIENT POPULATION. SEVERAL JOB POSTINGS IN THE HOSPITAL REQUIRE EMPLOYEES TO BE BILINGUAL IN EITHER SPANISH OR VIETNAMESE. GRACE HOSPITAL IS INVOLVED IN MANY COMMUNITY ACTIVITIES, INCLUDING HEALTH FAIRS, SPECIAL HEALTH-RELATED PRESENTATIONS, AND SPONSORSHIPS IN HEALTHCARE EDUCATION. IN ADDITION, THE HOSPITAL SPONSORS MEETINGS FOR MANY NON-PROFIT COMMUNITY ORGANIZATIONS. THE BOARD OF DIRECTORS, MEDICAL STAFF, AND MANAGEMENT OF GRACE HOSPITAL ARE COMMITTED TO THE PROVISION OF QUALITY SPECIALTY HEALTHCARE SERVICES, AS A LONG-TERM HOSPITAL, AND FULFILLING A LEADERSHIP ROLE IN THE COMMUNITY. DESPITE CHALLENGING ECONOMIC TIMES, GRACE HOSPITAL HAS SUCCESSFULLY CONTINUED ITS ROLE OF COMMUNITY SERVICE AS ORIGINALLY ENVISIONED BY ITS FOUNDERS. | Description |
| Total Program Service Expense | 22261025 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 42 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 290 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 11 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 0 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | OH | StatesWhereCopyOfReturnIsFiled |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MICHELLE HENNIS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2164563880 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 17730 LORAIN AVENUE | AddressLine1 |
| City | CLEVELAND | City |
| State | OH | State |
| ZIP Code | 44111 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (15 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| WILLARD E BARTEL | ||||||||
| CHAIRPERSON | 1.00 | 0.00 | X | X | 0 | 0 | 0 | |
| MP PATEL MD | ||||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| ROBERT A GREVEY | ||||||||
| VICE CHAIRPERSON | 1.00 | 0.00 | X | X | 0 | 0 | 0 | |
| GERALD L JEPPE | ||||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| REV JOSEPH D MCNULTY | ||||||||
| SECRETARY | 1.00 | 0.00 | X | X | 0 | 0 | 0 | |
| JOHN H NICKELS | ||||||||
| DIRECTOR OF MEDICAL STAFF | 10.00 | 0.00 | X | 91486 | 0 | 0 | ||
| JUDITH Z PETERS | ||||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| DEEPAK RAHEJA | ||||||||
| DIRECTOR OF NEUROLOGY | 5.00 | 0.00 | X | 0 | 0 | 0 | ||
| RICHARD J RYMOND | ||||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| PAUL C VENIZELOS | ||||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| DONALD L LONG CPA | ||||||||
| TREASURER | 1.00 | 0.00 | X | X | 0 | 0 | 0 | |
| RAJIVE KHANNA | ||||||||
| PRESIDENT & CEO | 40.00 | 0.00 | X | 214480 | 0 | 2431 | ||
| ROBERT P RANGE | ||||||||
| PRESIDENT & CEO - GRACE CENTER | 20.00 | 20.00 | X | 288269 | 0 | 0 | ||
| MICHELLE HENNIS | ||||||||
| DIRECTOR OF FINANCE | 40.00 | 0.00 | X | 104938 | 0 | 0 | ||
| BARBARA J MORAN | ||||||||
| CNO/COO | 40.00 | 0.00 | 127429 | 0 | 0 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 826602 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 2431 | TotalOtherCompensation |
| Number Individuals GT100 K | 4 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (4 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| CORNERSTONE HEALTHCARE GROUP HOLDING IN | |||||
| 13455 NOEL ROAD SUITE 1320 | DALLAS | TX | 75240 | CONSULTING | 1420000 |
| MAXIM HEALTHCARE SERVICES INC | |||||
| 13841 COLLECTIONS DR | CHICAGO | IL | 60693 | EMPLOYMENT AGENCY | 544490 |
| SS&G HEALTHCARE SERVICES LLC | |||||
| 275 SPRINGSIDE DR SUITE 100 | AKRON | OH | 44333 | BILLING SERVICE | 274258 |
| THE CAREER PLAZA INC | |||||
| 7326 INDUSTRIAL PARK BLVD | MENTOR | OH | 44060 | EMPLOYMENT AGENCY | 129181 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 4 | NumberOfContractorsGT100K |
| All Other Contributions | 408352 | AllOtherContributions |
| Total Contributions | 408352 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT SERVICE REVENU | 624100 | 27094305 | 27094305 |
| SPECIALTY HOSPITAL OF | 624100 | 662669 | 662669 |
| OTHER PROGRAM SERVICE | 624100 | 152724 | 152724 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 27909698 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 248200 | TotalRevenueColumn |
| Related Or Exempt Function Income | 248200 | RelatedOrExemptFunctionIncome |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 44465 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 44465 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 44465 | TotalRevenueColumn |
| Exclusion | $44,465 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 3000 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 0 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 3000 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3000 | TotalRevenueColumn |
| Exclusion | $3,000 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 28613715 | TotalRevenueColumn |
| Related Or Exempt Function Income | 28157898 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $47,465 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 94969 | Total |
| Program Services | 94969 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 699173 | Total |
| Program Services | 91486 | ProgramServices |
| Management And General | 607687 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9282168 | Total |
| Program Services | 8656112 | ProgramServices |
| Management And General | 626056 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1021397 | Total |
| Program Services | 895147 | ProgramServices |
| Management And General | 126250 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 830031 | Total |
| Program Services | 727435 | ProgramServices |
| Management And General | 102596 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 79848 | Total |
| Management And General | 79848 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24331 | Total |
| Management And General | 24331 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1231636 | Total |
| Management And General | 1231636 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5400 | Total |
| Management And General | 5400 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1831648 | Total |
| Program Services | 1473355 | ProgramServices |
| Management And General | 358293 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 74485 | Total |
| Program Services | 53731 | ProgramServices |
| Management And General | 20754 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 56116 | Total |
| Program Services | 53742 | ProgramServices |
| Management And General | 2374 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 194621 | Total |
| Program Services | 189613 | ProgramServices |
| Management And General | 5008 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 369387 | Total |
| Program Services | 194245 | ProgramServices |
| Management And General | 175142 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| PURCHASED SERVICES-PROF | 5906954 | 5906954 | |
| SUPPLIES - MEDICAL | 3169435 | 3169435 | |
| EQUIPMENT RENTAL AND MA | 738988 | 645097 | 93891 |
| SUPPLIES - GENERAL | 145917 | 89410 | 56507 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 187274 | Total |
| Program Services | 20294 | ProgramServices |
| Management And General | 166980 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 25943778 | Total |
| Program Services | 22261025 | ProgramServices |
| Management And General | 3682753 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 210663 | BOY |
| EOY | 338752 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 78643 | BOY |
| EOY | 1500135 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5525158 | BOY |
| EOY | 4725820 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 251504 | BOY |
| EOY | 264571 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 84616 | BOY |
| EOY | 207392 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 10268520 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 9575827 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 702951 | BOY |
| EOY | 692693 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 326585 | BOY |
| EOY | 574785 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7616842 | BOY |
| EOY | 8185658 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14796962 | BOY |
| EOY | 16489806 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4461626 | BOY |
| EOY | 3545018 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1317415 | BOY |
| EOY | 488070 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1316022 | BOY |
| EOY | 1516066 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7095063 | BOY |
| EOY | 5549154 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 85057 | BOY |
| EOY | 2754994 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7616842 | BOY |
| EOY | 8185658 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7701899 | BOY |
| EOY | 10940652 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14796962 | BOY |
| EOY | 16489806 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 2669937 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 568816 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 32151 | OtherCostOrOtherBasis |
| Book Value | 32151 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4345664 | OtherCostOrOtherBasis |
| Depreciation | 4198369 | Depreciation |
| Book Value | 147295 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 145197 | OtherCostOrOtherBasis |
| Depreciation | 130786 | Depreciation |
| Book Value | 14411 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5704233 | OtherCostOrOtherBasis |
| Depreciation | 5246672 | Depreciation |
| Book Value | 457561 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 41275 | OtherCostOrOtherBasis |
| Book Value | 41275 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 692693 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | ASSETS HELD IN PERPETUAL TRUST | Description |
| Book Value | 8185658 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 8185658 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| CAPITAL LEASE OBLIGATIONS | $2,784 |
| EST SETTLEMENTS TO THIRD-PARTIES | $1,513,282 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1516066 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 29182531 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 568816 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 568816 | RevenueNotRptdF990 |
| Revenue Subtotal | 28613715 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 28613715 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 25943778 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 25943778 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 25943778 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X, LINE 2: | ReturnReference |
| Explanation | THE HOSPITAL FOLLOWS ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES TOPIC OF THE FASB ACCOUNTING STANDARDS CODIFICATION, WHICH ADDRESSES THE INFORMATION OF WHETHER TAX BENEFITS CLAIMED OR EXPECTED TO BE CLAIMED ON A TAX RETURN SHOULD BE RECORDED IN THE FINANCIAL STATEMENTS. UNDER THIS GUIDANCE, THE HOSPITAL MAY RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE-LIKELY-THAN-NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFITS RECOGNIZED IN THE FINANCIAL STATEMENTS FROM SUCH A POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. IN ADDITION, THE GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES ADDRESSES DE-RECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES ON INCOME TAXES, AND ACCOUNTING IN INTERIM PERIODS. MANAGEMENT HAS DETERMINED THAT THE EFFECTS OF THIS PRONOUNCEMENT TO BE INSIGNIFICANT, THEREFORE NO ADJUSTMENTS HAVE BEEN RECORDED AND NO FURTHER DISCLOSURES REQUIRED. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 0 | AmountsBudgetedForCharityCare |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 349 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 349 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4154469 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5161539 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -1007070 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4154818 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5161539 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -1006721 | NetCommunityBenefitExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4154818 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5161539 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -1006721 | NetCommunityBenefitExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $611,540 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 12508999 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 12620416 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -111417 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost Accounting System | X | CostAccountingSystem |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV
Name Of Entity NameOfEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 SPECIALTY HOSPITAL OF LORAIN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Ent Primary Activity | NOT-FOR-PROFIT LONG-TERM ACUTE CARE HOSPITAL IN LORAIN, OHIO | DescriptionEntPrimaryActivity |
| Organization Profit Or Ownership | 0.33330 | OrganizationProfitOrOwnership |
| Officers Etc Profit Or Ownership | 0.00000 | OfficersEtcProfitOrOwnership |
| Physicans Profit Or Ownership | 0.00000 | PhysicansProfitOrOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 5 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (5 entries)
| Facility NumberFacilityNumber | Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Licensed HospitalLicensedHospital | OtherOther | Facility Reporting GroupFacilityReportingGroup |
|---|---|---|---|---|---|---|---|
| GRACE FAIRVIEW | |||||||
| 1 | 18101 LORAIN AVE | CLEVELAND | OH | 44111 | X | LONG TERM ACUTE CARE | A |
| GRACE SOUTH POINTE | |||||||
| 2 | 20000 HARVARD AVE | CLEVELAND | OH | 44122 | X | LONG TERM ACUTE CARE | A |
| GRACE LAKEWOOD | |||||||
| 3 | 14519 DETROIT AVE | LAKEWOOD | OH | 44107 | X | LONG TERM ACUTE CARE | A |
| GRACE BEDFORD | |||||||
| 4 | 44 BLAINE AVENUE | BEDFORD | OH | 44146 | X | LONG TERM ACUTE CARE | A |
| SPECIALTY HOSPITAL OF LORAIN | |||||||
| 5 | 254 CLEVELAND AVE | AMHERST | OH | 44001 | X | LONG TERM ACUTE CARE | |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB (2 entries)
| Hospital Facility NumberHospitalFacilityNumber | CHNA ConductedCHNAConducted | Eligibility Criteria ExplainedEligibilityCriteriaExplained | Uses FPG FreeUsesFPGFree | FPG Free PercentFPGFreePercent | Uses FPG DiscountedUsesFPGDiscounted | FPG Discount PercentFPGDiscountPercent | Explains BasisExplainsBasis | Income LevelIncomeLevel | Medical IndigencyMedicalIndigency | Insurance StatusInsuranceStatus | Uninsured DiscountUninsuredDiscount | Medicaid MedicareMedicaidMedicare | State RegulationStateRegulation | Other FactorsOtherFactors | Explains Application MethodExplainsApplicationMethod | Includes Publicity MeasuresIncludesPublicityMeasures | Attached To InvoicesAttachedToInvoices | Actions On NonpaymentActionsOnNonpayment | Collection ActivitiesCollectionActivities | Nondiscrim Emergency Care PolicyNondiscrimEmergencyCarePolicy | No Emergency CareNoEmergencyCare | Other ReasonOtherReason | Used Other MethodUsedOtherMethod | Amounts Generally BilledAmountsGenerallyBilled | Gross ChargesGrossCharges |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SPECIALTY HOSPITAL OF LORAIN | |||||||||||||||||||||||||
| 5 | 0 | 1 | 1 | 100.000000000000 | 1 | 200.000000000000 | 1 | X | X | X | X | X | X | X | 1 | 1 | X | 1 | 0 | 0 | X | X | X | 0 | 0 |
| FACILITY REPORTING GROUP - A | |||||||||||||||||||||||||
| 0 | 1 | 1 | 100.000000000000 | 1 | 200.000000000000 | 1 | X | X | X | X | X | X | X | 1 | 1 | X | 1 | 0 | 0 | X | X | X | 0 | 0 | |
Form990 Schedule H Part VI Form990ScheduleHPartVI (35 entries)
| ExplanationExplanation | Return ReferenceReturnReference | IdentifierIdentifier |
|---|---|---|
| PART I, LINE 3C: N/A | ||
| PART I, LINE 6A: N/A | ||
| PART I, LINE 7: THE AMOUNTS REPORTED ON LINE B WERE GENERATED FROM THE MEDICAID COST REPORT FILED FOR FY2013 AND INCLUDE GRACE HOSPITAL'S PROPORTIONATE SHARE FROM SPECIALTY HOSPITAL OF LORAIN. NEGATIVE COMMUNITY BENEFIT REPRESENTS MEDICAID SURPLUS TO BE REPAID TO MEDICAID PROGRAM.ACUTE CARE HOSPITAL SERVICES RENDERED TO MEDICAID PROGRAM BENEFICIARIES ARE PAID AT PROSPECTIVELY DETERMINED RATES. THESE RATES VARY ACCORDING TO A PATIENT CLASSIFICATION SYSTEM THAT IS BASED ON CLINICAL, DIAGNOSTIC AND OTHER FACTORS. CAPITAL COSTS FOR MEDICAID INPATIENT SERVICES ARE REIMBURSED BASED ON A COST REIMBURSEMENT METHODOLOGY. THE HOSPITAL IS REIMBURSED FOR COST REIMBURSABLE ITEMS AT A TENTATIVE RATE WITH FINAL SETTLEMENT DETERMINED AFTER SUBMISSION OF ANNUAL COST REPORTS AND AUDITS THEREOF BY THE FISCAL INTERMEDIARY. | ||
| PART I, LINE 7G: N/A | ||
| PART II: N/A | ||
| PART III, LINE 4: IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR DOUBTFUL ACCOUNTS. IN ADDITION, MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE CONTRACTUAL ALLOWANCE. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND CO-PAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL IMMEDIATELY RESERVES THEIR BALANCES IN THE ALLOWANCE DOUBTFUL ACCOUNTS AND WRITES-OFF TO COLLECTION AFTER THE PATIENT IS BILLED FOUR TIMES, ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE AMOUNT REPORTED ON LINE 2 REPRESENTS GROSS CHARGES WRITTEN OFF DURING 2013. NO PORTION OF BAD DEBTS IS INCLUDED AS COMMUNITY BENEFIT. THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE AND NOT INCLUDED IN BAD DEBT EXPENSE. | ||
| PART III, LINE 8: MEDICARE SHORTHALL IS NOT TREATED AS COMMUNITY BENEFIT. THE AMOUNTS REPORTED WERE GENERATED FROM THE MEDICARE COST REPORT FILED FOR FY2013. INPATIENT ACUTE CARE SERVICES AND OUTPATIENT SERVICES RENDERED TO MEDICARE PROGRAM BENEFICIARIES ARE PAID AT PROSPECTIVELY DETERMINED RATES PER DISCHARGE. THESE RATES VARY ACCORDING TO A PATIENT CLASSIFICATION SYSTEM THAT IS BASED ON CLINICAL, DIAGNOSTIC, AND OTHER FACTORS. INPATIENT NONACUTE CARE SERVICES RELATED TO MEDICARE BENEFICIARIES ARE PAID BASED ON A COST REIMBURSEMENT METHODOLOGY. THE HOSPITAL IS REIMBURSED FOR COST REIMBURSABLE ITEMS AT TENTATIVE RATES WITH FINAL SETTLEMENT AFTER SUBMISSION OF ANNUAL COST REPORTS AND AUDITS THEREOF BY THE MEDICARE FISCAL INTERMEDIARY. | ||
| PART III, LINE 9B: FREE CARE WILL BE EXTENDED TO THOSE WHO QUALIFY FOR THESE REASONS: THE PATIENT IS UNINSURED, THE PATIENT IS NOT ELIGIBLE FOR MEDICAID OR PENDING MEDICAID APPROVAL,THE PATIENT IS DETERMINED TO BE UNABLE TO PAY FOR SERVICES PROVIDED, THE PATIENT IS UNABLE TO ACCEPT AN INSTALLMENT PAYMENT ARRANGEMENT, THE PATIENT IS BELOW 200% OF THE FEDERAL POVERTY GUIDELINES, AND THE PATIENT IS A HARDSHIP CASE AS DESIGNATED BY THE PHYSICIAN AND GRACE HOSPITAL. THE PATIENT WILL NEED TO COMPLETE A CHARITY CARE FORM AND RETURN TO GRACE HOSPITAL FOR DETERMINATION OF FREE CARE. GRACE HOSPITAL STAFF OR ITS BILLING REPRESENTATIVES WILL HELP THE PATIENT COMPLETE THE FORM ON REQUEST. ULTIMATELY, IT IS THE PATIENT'S RESPONSIBILITY TO COMPLETE THE FORM. HE/SHE WILL CONTINUE TO BE FULLY RESPONSIBLE FOR THE BILL UNTIL A DETERMINATION IS MADE. DOCUMENTED PROOF OF INCOME IS REQUIRED. | ||
| IN FISCAL YEAR 2008, GRACE HOSPITAL (HOSPITAL) ENTERED INTO A JOINT VENTURE WITH TWO OTHER HEALTHCARE PROVIDERS TO OPERATE SPECIALTY HOSPITAL OF LORAIN (SPECIALTY), A NOT-FOR-PROFIT LONG-TERM ACUTE CARE HOSPITAL IN LORAIN, OHIO. THE PARTIES TO THE JOINT VENTURE OPERATE AS MEMBER ORGANIZATIONS OF SPECIALTY, EACH WITH A 33-1/3% INTEREST. EACH MEMBER ORGANIZATION HAS ALSO AGREED TO SERVE AS CO-GUARANTORS WITH SEVERAL LIABILITIES ON A LINE OF CREDIT NOT TO EXCEED $1,000,000, WHICH IS SECURED BY SPECIALTY'S ASSETS. AS OF JUNE 30, 2013, THE OUTSTANDING BALANCE ON THIS LINE OF CREDIT IS $150,603.IN FISCAL YEAR 2008, THE HOSPITAL ENTERED INTO A MANAGERIAL, AS WELL AS, VARIOUS CLINICAL SERVICE AGREEMENTS WITH SPECIALTY. THE AGREEMENTS SPECIFY THE HOSPITAL IS TO PROVIDE MANAGERIAL AND CLINICAL SERVICES AT COST AND COST PLUS 3%, RESPECTIVELY. FOR THE YEARS ENDED JUNE 30, 2013 AND 2012, REVENUE RECOGNIZED AS A RESULT OF THESE AGREEMENTS IS REPORTED ON THE HOSPITAL'S STATEMENTS OF OPERATIONS TOTALING $662,669 AND $643,387, RESPECTIVELY. RECEIVABLES FOR THESE SERVICES, IN ADDITION TO OTHER REIMBURSEMENTS, ARE REPORTED ON THE HOSPITAL'S STATEMENTS OF FINANCIAL POSITION TOTALING $214,519 AND $121,245 AT JUNE 30, 2013 AND 2012, RESPECTIVELY.THE HOSPITAL'S INVESTMENT IN SPECIALTY IS CARRIED ON THE HOSPITAL'S STATEMENT OF FINANCIAL POSITION AT JUNE 30, 2013 AND 2012. THESE ASSETS REPRESENT THE HOSPITAL'S PROPORTIONATE SHARE OF SPECIALTY'S NET ASSET BALANCES, WHICH ARE RECORDED ON THE EQUITY METHOD.GRACE HOSPITAL'S PROPORTIONATE SHARE OF SPECIALTY'S FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST AND BAD DEBTS HAVE BEEN INCLUDED IN SCHEDULE H. | PART IV, JOINT VENTURES | |
| PART V, SECTION B, LINE 12H: THE FOLLOWING STRUCTURE WILL BE UTILIZED TO DETERMINE THE AMOUNT OF FREE CARE TO BE PROVIDED. HOUSEHOLD INCOME AND THE NUMBER OF PEOPLE LIVING IN HOUSEHOLD WILL BE THE TWO MAJOR CRITERIA USED TO DETERMINE IF A PATIENT IS ELIGIBLE FOR FREE CARE. EXTENUATING CIRCUMSTANCES SHOULD BE NOTED AND MAY INCLUDE INFORMATION SUPPLIED TO SUPPORT EXCEPTIONAL SCENARIOS INCLUDING A TERMINAL ILLNESS, DEATH OF A SPOUSE, OR CATASTROPHIC PROBLEMS. | SPECIALTY HOSPITAL OF LORAIN | |
| PART V, SECTION B, LINE 19D: SPECIALTY HOSPITAL OF LORAIN IS A LONG TERM ACUTE CARE (LTAC) FACILITY LOCATED ON A FLOOR OF AMHERST HOSPITAL. DUE TO THE TYPE OF SERVICES PROVIDED, SHL DOES NOT PROVIDE CARE FOR EMERGENCY MEDICAL CONDITIONS. IF FULL-SERVICE EMERGENCY ROOM CARE IS NEEDED, THE FACILITIES OF AMHERST HOSPITAL ARE AVAILABLE. | SPECIALTY HOSPITAL OF LORAIN | |
| PART V, SECTION B, LINE 20D: A SLIDING SCALE FEE SCHEDULE IS USED TO DETERMINE THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS. | SPECIALTY HOSPITAL OF LORAIN | |
| PURSUANT TO INTERNAL REVENUE BULLETIN 2014-3 AND IRS NOTICE 2014-3, GRACE HOSPITAL (GRACE) IS DISCLOSING FAILURE TO COMPLY WITH IRC SECTION 501(R)(3) WHICH REQUIRES A HOSPITAL ORGANIZATION TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). UNDER PROP. REG. 1.501(R)-2(C), "A HOSPITAL FACILITY'S FAILURE TO MEET ONE OR MORE OF THE REQUIREMENTS DESCRIBED IN PROP. REG. 1.501(R)-3 THROUGH 1.501(R)-6 THAT IS NEITHER WILLFUL NOR EGREGIOUS SHALL BE EXCUSED FOR PURPOSES OF THIS SECTION IF THE HOSPITAL FACILITY CORRECTS AND MAKES DISCLOSURE IN ACCORDANCE WITH THE RULES SET FORTH IN THE GUIDANCE." GRACE'S FAILURE TO COMPLY WITH THE REQUIREMENT TO CONDUCT A CHNA WAS NEITHER WILLFUL NOR EGREGIOUS. GRACE IS A LONG-TERM ACUTE CARE HOSPITAL (LTAC) THAT OPERATES ON FLOORS WITHIN THREE CLEVELAND CLINIC HOSPITALS AND ONE UNIVERSITY HOSPITAL FACILITY. FOR EACH HOSPITAL FACILITY THAT GRACE OPERATES WITHIN, A CHNA WAS CONDUCTED BY THAT HOSPITAL SYSTEM. DUE TO LIMITED RESOURCES, STAFF LIMITATIONS AND BASED ON THE SERVICES THAT GRACE PROVIDES, GRACE WAS NOT AWARE OF THE REQUIREMENT TO CONDUCT A CHNA AND DID NOT CONDUCT A CHNA FOR FISCAL YEAR 2013 (7/1/2012 - 6/30/2013). UPON CONSULTATION FROM OUTSIDE CONSULTANTS, GRACE WAS MADE AWARE OF THE REQUIREMENT. ONCE ADVISED ON REQUIREMENT TO CONDUCT A CHNA, GRACE BEGAN PROCESS OF IMPLEMENTING A PLAN TO CONDUCT A CHNA AND WILL PREPARE AND ADOPT A CHNA REPORT CONTAINING ALL OF THE REQUIRED ELEMENTS AND WILL MAKE THE CHNA REPORT WIDELY AVAILABLE ON A WEB SITE WITHIN THE MEANING OF PROP. REG. 1.501(R)-1(C)(4) OF THE 2013 PROPOSED REGULATIONS. | PART V, SECTION B, QUESTION #1 | FAILURE TO CONDUCT CHNA |
| PART VI, LINE 2: THE HOSPITAL PRESENTLY SPONSORS SEVERAL INPATIENT SERVICES INCLUDING COMPLEX MEDICAL, PULMONARY, REHABILITATION, VENTILATOR WEANING, LEFT VENTRICAL ASSIST DEVICE, TRANSPLANT SUPPORT, WOUND CARE, AND NEUROLOGICAL REHABILITATION PROGRAMS. THESE SERVICES ARE PROVIDED AT INPATIENT SATELLITES LOCATED WITHIN AMHERST, FAIRVIEW, HURON, LAKEWOOD, AND SOUTH POINTE HOSPITALS. GRACE HOSPITAL IS COMMITTED TO PROVIDING PERSONALIZED HEALTHCARE CHARACTERIZED BY QUALITY, ACCESSIBILITY, EFFICIENCY, AND COST EFFECTIVENESS. THE HOSPITAL IS SENSITIVE TO AGE, CULTURAL, AND ECONOMIC VARIATIONS, AND IS CONTINUOUSLY ASSESSED AND IMPROVED THROUGH A QUALITY MANAGEMENT PROGRAM. GRACE VOLUNTARILY MAINTAINS A CHARITY CARE POLICY THAT PROVIDES CARE TO INDIVIDUALS REGARDLESS OF ABILITY TO PAY. THE HOSPITAL IS ALSO COMMITTED TO EMPLOYING INDIVIDUALS TO MATCH CULTURAL DIVERSITY OF ITS PATIENT POPULATION. SEVERAL JOB POSTINGS IN THE HOSPITAL REQUIRE EMPLOYEES TO BE BILINGUAL IN EITHER SPANISH OR VIETNAMESE. GRACE HOSPITAL IS INVOLVED IN MANY COMMUNITY ACTIVITIES, INCLUDING HEALTH FAIRS, SPECIAL HEALTH-RELATED PRESENTATIONS, AND SPONSORSHIPS IN HEALTHCARE EDUCATION. IN ADDITION, THE HOSPITAL SPONSORS MEETINGS FOR MANY NON-PROFIT COMMUNITY ORGANIZATIONS. THE BOARD OF DIRECTORS, MEDICAL STAFF, AND MANAGEMENT OF GRACE HOSPITAL ARE COMMITTED TO THE PROVISION OF QUALITY SPECIALTY HEALTHCARE SERVICES, AS A LONG-TERM HOSPITAL, AND FULFILLING A LEADERSHIP ROLE IN THE COMMUNITY. DESPITE CHALLENGING ECONOMIC TIMES, GRACE HOSPITAL HAS SUCCESSFULLY CONTINUED ITS ROLE OF COMMUNITY SERVICE AS ORIGINALLY ENVISIONED BY ITS FOUNDERS. | ||
| PART VI, LINE 3: INFORMATION ABOUT ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS IS DESCRIBED ON THE PATIENT'S BILL. THE PATIENT WILL NEED TO COMPLETE A CHARITY CARE FORM AND RETURN TO GRACE FOR DETERMINATION OF FREE CARE. GRACE STAFF OR ITS BILLING REPRESENTATIVES WILL HELP THE PATIENT COMPLETE THE FORM ON REQUEST. | ||
| PART VI, LINE 4: GRACE HOSPITAL IS A LONG-TERM ACUTE CARE HOSPITAL (LTACH) DEDICATED TO PROVIDING HIGH QUALITY PRIMARY AND SECONDARY HEALTH CARE SERVICES TO MEET THE NEEDS OF LOCAL COMMUNITIES IN NORTHEAST OHIO. | ||
| PART VI, LINE 5: PART VI, LINE 5: ON APRIL 19, 2005, THE GRACE CENTER (CENTER) WAS INCORPORATED TO PROMOTE HEALTH AND WELLNESS IN THE GEOGRAPHIC AREA HISTORICALLY SERVED BY GRACE HOSPITAL (HOSPITAL). THE CENTER IS PLANNED AS A SPECIALTY HEALTHCARE ORGANIZATION TO PROVIDE CONSULTATIVE, DIAGNOSTIC, REHABILITATIVE, EDUCATION, FITNESS, THERAPEUTIC, AND PHARAMCY PROGRAMS ON AN OUTPATIENT AND INPATIENT BASIS TO MEET THE NEEDS OF THE ADULT POPULATION. TO ASSIST WITH THE ESTABLISHMENT OF THE CENTER, IN DECEMBER 2006, THE HOSPITAL ENTERED INTO AN AGREEMENT WITH THE CENTER FOR LEASING THE WEST 14TH FACILITIES (FACILITIES) AT A RENTAL AMOUNT OF $1 PER YEAR FOR FIVE YEARS, WITH AN AUTOMATIC FIVE-YEAR RENEWAL TERM. IN RETURN, THE CENTER WAS TO PROVIDE CHARITABLE SERVICES FOCUSED ON THE TREMONT AREA, IMPROVE THE FACILITIES AND ASSUME OPERATIONAL EXPENSES. THE LEASE ALSO PROVIDES THE CENTER AN OPTION TO PURCHASE THE FACILITIES FOR $1 AT ANY TIME DURING THE TERM OF THE LEASE PROVIDED VARIOUS OPERATING COVENANTS ARE MET. THE HOSPITAL'S BOARD HAD ALSO APPROVED A RESOLUTION TO PROVIDE THE CENTER WITH A $750,000 OPERATING TERM LOAN AND TO GUARANTEE A $3,500,000 LOAN TO RENOVATE THE FACILITIES. THE LEASE, THE GUARANTEE OF A LOAN, AND THE OPERATING LOAN ARE ALL CROSS-DEFAULTED AND SECURED BY THE FACILITIES. IF A MATERIAL DEFAULT OCCURS UNDER THE LEASE, THE OPERATING TERM LOAN OR THE GUARANTEE IS DRAWN ON, THE HOSPITAL WILL HAVE THE RIGHT TO TERMINATE THE LEASE OR TAKE BACK THE FACILITIES. FINALLY, IF THE CENTER EXERCISES ITS PURCHASE OPTION, THE HOSPITAL WILL FORGIVE ALL AMOUNTS UNDER THE OPERATING TERM LOAN DUE TO THE HOSPITAL. APPROXIMATELY $976,000 AND $881,000 AS OF JUNE 30, 2013 AND 2012, RESPECTIVELY, HAD BEEN EXPENSED BY THE HOSPITAL TO THE CENTER UNDER THE OPERATING TERM LOAN. THE HOSPITAL CONTRIBUTED FUNDS TO THE CENTER TOTALING $94,969 AND $109,301 DURING 2013 AND 2012, RESPECTIVELY, WHICH HAS BEEN TREATED AS CONTRIBUTIONS TO THE CENTER ON THE STATEMENTS OF OPERATIONS. IN ADDITION, AS OF JUNE 30, 2013 AND 2012, GRACE CENTER HAS DRAWN $276,223 ON A LOAN THAT THE HOSPITAL SERVES AS THE GUARANTOR.DUE TO OPERATIONAL AND FINANCIAL CONSIDERATIONS, THE HOSPITAL AND CENTER ELECTED TO NOT MOVE FORWARD WITH IMPLEMENTING THE LEASE AGREEMENT. INSTEAD, THE HOSPITAL PLANS TO ESTABLISH A NOT-FOR-PROFIT FOUNDATION WHICH WOULD WHOLLY OWN BOTH THE HOSPITAL AND CENTER. THE FOUNDATION WOULD THEN PROVIDE THE REMAINING SUPPORT REQUIRED TO START-UP THE CENTER. | ||
| PART VI, LINE 6: N/A | ||
| N/A | PART VI, LINE 7 | |
| SEE BELOW | PART V, LINE 8 FACILITY REPORTING GROUP A | |
| THE FOLLOWING STRUCTURE WILL BE UTILIZED TO DETERMINE THE AMOUNT OF FREE CARE TO BE PROVIDED. HOUSEHOLD INCOME AND THE NUMBER OF PEOPLE LIVING IN HOUSEHOLD WILL BE THE TWO MAJOR CRITERIA USED TO DETERMINE IF A PATIENT IS ELIGIBLE FOR FREE CARE. EXTENUATING CIRCUMSTANCES SHOULD BE NOTED AND MAY INCLUDE INFORMATION SUPPLIED TO SUPPORT EXCEPTIONAL SCENARIOS INCLUDING A TERMINAL ILLNESS, DEATH OF A SPOUSE, OR CATASTROPHIC PROBLEMS. | PART V, SECTION B, LINE 12H: | FACILITY 1 -- GRACE FAIRVIEW |
| GRACE HOSPITAL IS A LONG TERM ACUTE CARE (LTAC) FACILITY LOCATED ON A FLOOR OF FAIRVIEW HOSPITAL, A CLEVELAND CLINIC HOSPITAL. DUE TO THE TYPE OF SERVICES PROVIDED, GRACE DOES NOT PROVIDE CARE FOR EMERGENCY MEDICAL CONDITIONS. IF FULL-SERVICE EMERGENCY ROOM CARE IS NEEDED, THE FACILITIES OF FAIRVIEW HOSPITAL ARE AVAILABLE. | PART V, SECTION B, LINE 19D: | FACILITY 1 -- GRACE FAIRVIEW |
| A SLIDING SCALE FEE SCHEDULE IS USED TO DETERMINE THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS. | PART V, SECTION B, LINE 20D: | FACILITY 1 -- GRACE FAIRVIEW |
| PART V, SECTION B, LINE 12H: | FACILITY 3 -- GRACE LAKEWOOD | |
| THE FOLLOWING STRUCTURE WILL BE UTILIZED TO DETERMINE THE AMOUNT OF FREE CARE TO BE PROVIDED. HOUSEHOLD INCOME AND THE NUMBER OF PEOPLE LIVING IN HOUSEHOLD WILL BE THE TWO MAJOR CRITERIA USED TO DETERMINE IF A PATIENT IS ELIGIBLE FOR FREE CARE. EXTENUATING CIRCUMSTANCES SHOULD BE NOTED AND MAY INCLUDE INFORMATION SUPPLIED TO SUPPORT EXCEPTIONAL SCENARIOS INCLUDING A TERMINAL ILLNESS, DEATH OF A SPOUSE, OR CATASTROPHIC PROBLEMS. | PART V, SECTION B, LINE 12H: | FACILITY 3 -- GRACE LAKEWOOD |
| GRACE HOSPITAL IS A LONG TERM ACUTE CARE (LTAC) FACILITY LOCATED ON A FLOOR OF LAKEWOOD HOSPITAL, A CLEVELAND CLINIC HOSPITAL. DUE TO THE TYPE OF SERVICES PROVIDED, GRACE DOES NOT PROVIDE CARE FOR EMERGENCY MEDICAL CONDITIONS. IF FULL-SERVICE EMERGENCY ROOM CARE IS NEEDED, THE FACILITIES OF LAKEWOOD HOSPITAL ARE AVAILABLE. | PART V, SECTION B, LINE 19D: | FACILITY 3 -- GRACE LAKEWOOD |
| A SLIDING SCALE FEE SCHEDULE IS USED TO DETERMINE THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS. | PART V, SECTION B, LINE 20D: | FACILITY 3 -- GRACE LAKEWOOD |
| PART V, SECTION B, LINE 12H: | FACILITY 2 -- GRACE SOUTH POINTE | |
| THE FOLLOWING STRUCTURE WILL BE UTILIZED TO DETERMINE THE AMOUNT OF FREE CARE TO BE PROVIDED. HOUSEHOLD INCOME AND THE NUMBER OF PEOPLE LIVING IN HOUSEHOLD WILL BE THE TWO MAJOR CRITERIA USED TO DETERMINE IF A PATIENT IS ELIGIBLE FOR FREE CARE. EXTENUATING CIRCUMSTANCES SHOULD BE NOTED AND MAY INCLUDE INFORMATION SUPPLIED TO SUPPORT EXCEPTIONAL SCENARIOS INCLUDING A TERMINAL ILLNESS, DEATH OF A SPOUSE, OR CATASTROPHIC PROBLEMS. | PART V, SECTION B, LINE 12H: | FACILITY 2 -- GRACE SOUTH POINTE |
| GRACE HOSPITAL IS A LONG TERM ACUTE CARE (LTAC) FACILITY LOCATED ON A FLOOR OF SOUTH POINTE HOSPITAL, A CLEVELAND CLINIC HOSPITAL. DUE TO THE TYPE OF SERVICES PROVIDED, GRACE DOES NOT PROVIDE CARE FOR EMERGENCY MEDICAL CONDITIONS. IF FULL-SERVICE EMERGENCY ROOM CARE IS NEEDED, THE FACILITIES OF SOUTH POINTE HOSPITAL ARE AVAILABLE. | PART V, SECTION B, LINE 19D: | FACILITY 2 -- GRACE SOUTH POINTE |
| A SLIDING SCALE FEE SCHEDULE IS USED TO DETERMINE THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS. | PART V, SECTION B, LINE 20D: | FACILITY 2 -- GRACE SOUTH POINTE |
| PART V, SECTION B, LINE 12H: | FACILITY 4 -- GRACE BEDFORD | |
| THE FOLLOWING STRUCTURE WILL BE UTILIZED TO DETERMINE THE AMOUNT OF FREE CARE TO BE PROVIDED. HOUSEHOLD INCOME AND THE NUMBER OF PEOPLE LIVING IN HOUSEHOLD WILL BE THE TWO MAJOR CRITERIA USED TO DETERMINE IF A PATIENT IS ELIGIBLE FOR FREE CARE. EXTENUATING CIRCUMSTANCES SHOULD BE NOTED AND MAY INCLUDE INFORMATION SUPPLIED TO SUPPORT EXCEPTIONAL SCENARIOS INCLUDING A TERMINAL ILLNESS, DEATH OF A SPOUSE, OR CATASTROPHIC PROBLEMS. | PART V, SECTION B, LINE 12H: | FACILITY 4 -- GRACE BEDFORD |
| GRACE HOSPITAL IS A LONG TERM ACUTE CARE (LTAC) FACILITY LOCATED ON A FLOOR OF BEDFORD MEDICAL CENTER, A CAMPUS OF UNIVERSITY HOSPITALS REGIONAL HOSPITALS. DUE TO THE TYPE OF SERVICES PROVIDED, GRACE DOES NOT PROVIDE CARE FOR EMERGENCY MEDICAL CONDITIONS. IF FULL-SERVICE EMERGENCY ROOM CARE IS NEEDED, THE FACILITIES OF BEDFORD HOSPITAL ARE AVAILABLE. | PART V, SECTION B, LINE 19D: | FACILITY 4 -- GRACE BEDFORD |
| A SLIDING SCALE FEE SCHEDULE IS USED TO DETERMINE THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS. | PART V, SECTION B, LINE 20D: | FACILITY 4 -- GRACE BEDFORD |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE GRACE CENTER | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2307 WEST 14TH STREET | AddressLine1 |
| City | CLEVELAND | City |
| State | OH | State |
| ZIP Code | 44113 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 204577277 | EINOfRecipient |
| Amount Of Cash Grant | 94969 | AmountOfCashGrant |
| Purpose Of Grant | GENERAL PURPOSE | PurposeOfGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: THE GRANT WAS ISSUED TO A RELATED PARTY. THE FUNDS ARE MONITORED BY THOSE BOARD MEMBERS WHO OVERLAP WITHIN THE ENTITIES. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RAJIVE KHANNA | ||||||||||||||
| PRESIDENT & CEO | 214480 | 0 | 0 | 0 | 0 | 0 | 2145 | 0 | 286 | 0 | 216911 | 0 | 0 | 0 |
| ROBERT P RANGE | ||||||||||||||
| PRESIDENT & CEO - GRACE CENTER | 288269 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 288269 | 0 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (4 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE HOSPITAL CONTRACTS WITH AN OUTSIDE ACCOUNTING FIRM FOR THE PREPARATION OF THE FORM 990. THE HOSPITAL PROVIDES MATERIAL BASED ON REQUESTS FROM THE ACCOUNTING FIRM. MOST OF THE INFORMATION IS PROVIDED BY THE DIRECTOR OF FINANCE. THE FINAL FORM IS REVIEWED BY THE DIRECTOR OF FINANCE AND THE CEO. A COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF TRUSTEES. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE COMPENSATION OF THE ORGANIZATION'S CEO IS DETERMINED BY THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XII, LINE 2C | THE ORGANIZATION HAS NOT CHANGED ITS OVERSIGHT OR THE SELECTION PROCESS DURING THE TAX YEAR. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE GRACE CENTER | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2307 WEST 14TH STREET | AddressLine1 |
| City | CLEVELAND | City |
| State | OH | State |
| ZIP Code | 44113 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 204577277 | EIN |
| Primary Activity | HEALTHCARE | PrimaryActivity |
| Legal Domicile State | OH | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRACE FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C | TypeOfEntity |
| Controlled Org | 1 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 1 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| THE GRACE CENTER | ||
| B | 94969 | CASH |
| THE GRACE CENTER | ||
| D | 276223 | OUTSTANDING LOAN GUARANTEE |